New Year’s Eve and New Year’s Day always provide excellent opportunities for journalists to look, Janus-like, backwards into the recent past, and forward into the immediate future, and the flipping of the calendar from 2017 to 2018 is no exception.
The big-picture reality? As we enter 2018, the leaders of the most advanced multispecialty medical groups are absolutely skating to where the puck is headed in U.S. healthcare, leveraging data analytics, and aligning incentives, in order to take on increased risk in risk-bearing contracts. Indeed, for those who closely observed key trends in 2017, it has been clear that is those advanced physician organizations that are pointing the way, as we edge into 2018, facing an operating environment with accelerating policy, business, and IT-strategic challenges.
As Managing Editor Rajiv Leventhal reported in a December 13 article, “Medical groups and health systems that are members of AMGA (the American Medical Group Association) expect that nearly 60 percent of their revenues from Medicare will be from risk-based products by 2019, according to the results from a recent survey.” Leventhal noted that AMGA’s third annual risk survey, which encompassed complete responses from 74 of that association’s member medical groups, found that, “[I]f Medicare Advantage, bundled payments, Medicaid managed care organizations, and Medicare accountable care organizations (ACOs) are factored together, alternatives to Medicare fee-for-service (FFS) are predicted to account for 59 percent of AMGA member’s revenues by 2019, compared to 53 percent in 2017.”
Granted, AMGA’s member medical groups by and large represent the most advanced, as well as the largest, independent multispecialty medical groups operating in the U.S.; further, lumping Medicare Advantage contracts together with bundled-payment contracts and participation in the MSSP (Medicare Shared Savings Program) for ACOs is a bit facile. That said, the fact that the most sophisticated medical groups anticipate three-fifths of their revenues to come from risk, within the next year, is quite significant indeed.
Meanwhile, what did AMGA member-group executives cite as the number-one impediment to taking on risk? The white paper, entitled “Taking Risk, 3.0: Medical Groups Are Moving to Risk … Is Anyone Else? AMGA’s Third Annual Survey on Taking Risk,” noted that “The most critical obstacles involve data, particularly the lack of access to administrative claims data, health plan data that is not actionable, and reporting data to duplicative quality measurement programs. Internal impediments revolve around the need to develop and finance the infrastructure necessary to take risk.”
In our editorial team’s reporting, we’ve found consistently, in interviewing provider leaders over the past year, that a lot of really basic “blocking and tackling” elements of leveraging data—and especially of “marrying” clinical and claims data—remain core obstacles to improving performance in risk-based contracting. Indeed, that issue remains one of the biggest day-to-day problems for both hospital and medical group leaders moving into risk.
Perhaps that’s why the actual, practical planning for the implementation of artificial intelligence-based development work in patient care organizations has not yet reached the level of prioritization that might be expected. As Associate Editor Heather Landi reported on December 7, “A new survey provides some insight into how hospital and health system leaders are prioritizing healthcare technology investments for next year with strong indications that healthcare leaders are focused on investing in proven technology solutions that will have an immediate impact, and are proceeding cautiously with emerging technology like artificial intelligence (AI). The survey, conducted by the Pittsburgh-based Center for Connected Medicine (CCM) in partnership with the Health Management Academy, reflects the opinions of healthcare C-suite leaders from 20 major U.S. health systems across the country.”
Interviewing Gary Bisbee Jr., Ph.D., co-founder, chairman and CEO of the Health Management Academy, and Bryan Clutz, Ph.D., researcher director at the Academy and Melissa Stahl, research manager, about the implications of the survey’s findings, Landi wrote, “An overall emerging theme from the survey was that while health system leaders are excited about the prospects of emerging technologies such as AI and machine learning, yet the majority are proceeding cautiously on these technologies and continue to be focused, instead, on proven technologies and IT initiatives, such as enhancing existing electronic health record (EHR) systems, standardizing IT platforms and cybersecurity solutions.”
As the article noted, “[T]he survey found that more than half of health systems currently use AI, but 63 percent of hospital IT executives ranked the implementation of AI solutions as a ‘low’ or ‘very low’ priority for 2018. Executives reported that AI is in its early stages where proving its value is difficult and the technology still needs refinement, but they expect the technology to have greater impact in the future, according to the survey report. And, responding health systems expect to spend an average of 2.6 percent of their IT budget on AI in 2018.”